Diagnosing Myelodysplastic Syndrome in a Rural Setting: A Case Report

Myelodysplastic syndrome (MDS) is a rare group of diseases defined by cytopenias, abnormal cellular morphology and various symptoms including anemia, infections, and bleeding. This wide array of nonspecific symptoms creates a challenge in diagnosing MDS, especially in a rural setting. In this case study we present an 81-year-old female who presented to a rural family medicine clinic for evaluation of a severe macrocytic anemia that persisted despite repeated transfusions. The patient was evaluated with a variety of labs including complete blood count, vitamin levels, endocrine evaluation and immunoglobulins before being referred to hematology for a bone marrow biopsy and diagnosis of MDS. This case highlights the challenges of diagnosing MDS in a rural setting and discusses methods that can be used by primary care providers to differentiate MDS from other hematological conditions prior to a subspecialist referral.